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http://hdl.handle.net/1942/19830
Title: | Response and tolerance to oral vasodilator up-titration after intravenous vasodilator therapy in advanced decompensated heart failure | Authors: | VERBRUGGE, Frederik DUPONT, Matthias Finucan, Michael Gabi, Alaa Hawwa, Noel MULLENS, Wilfried Taylor, David O. Young, James B. Starling, Randall C. Tang, W. H. Wilson |
Issue Date: | 2015 | Publisher: | WILEY-BLACKWELL | Source: | EUROPEAN JOURNAL OF HEART FAILURE, 17 (9), p. 956-963 | Abstract: | Aims The aim of this study was to assess the haemodynamic response and tolerance to aggressive oral hydralazine/isosorbide dinitrate (HYD/ISDN) up-titration after intravenous vasodilator therapy in advanced decompensated heart failure (ADHF). Methods and results Medical records of 147 consecutive ADHF patients who underwent placement of a pulmonary artery catheter and received intravenous vasodilator therapy were reviewed. Intravenous sodium nitroprusside and sodium nitroglycerin as first-line agent for those with preserved blood pressures were utilized in 143 and 32 patients, respectively. Sixty-one percent of patients were converted to oral HYD/ISDN combination therapy through a standardized conversion protocol. These patients had a significantly higher admission mean pulmonary arterial wedge pressure compared with patients not converted (28 +/- 7 vs. 25 +/- 8 mmHg, respectively; P-value 0.024). Beneficial haemodynamic response to decongestive therapy, defined as low cardiac filling pressures and cardiac index >= 2.20 L/min/m(2) without emergent hypotension, was achieved in 32% and 29% of patients who did or did not receive oral HYD/ISDN, respectively (P-value 0.762). HYD/ISDN dosing was progressively and consistently decreased up to the moment of hospital discharge and during outpatient follow-up, primarily due to incident hypotension. Conclusion The use of a standardized haemodynamically guided up-titration protocol for conversion from intravenous to oral vasodilators may warrant subsequent dose reductions upon stabilization. | Notes: | [Verbrugge, Frederik H.; Dupont, Matthias; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium. [Verbrugge, Frederik H.; Mullens, Wilfried] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Verbrugge, Frederik H.; Finucan, Michael; Gabi, Alaa; Hawwa, Noel; Taylor, David O.; Young, James B.; Starling, Randall C.; Tang, W. H. Wilson] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH USA. | Keywords: | Haemodynamics; Hydralazine; Isosorbide dinitrate; Systolic heart failure; Vasodilator agents;haemodynamics; hydralazine; isosorbide dinitrate; systolic heart failure; vasodilator agents | Document URI: | http://hdl.handle.net/1942/19830 | ISSN: | 1388-9842 | e-ISSN: | 1879-0844 | DOI: | 10.1002/ejhf.324 | ISI #: | 000363046600013 | Rights: | © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2016 |
Appears in Collections: | Research publications |
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